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Author Spotlight: Rehabilitation of Stroke Patients With a Digital Occupational Training System
Published on: December 29, 2023
Effect of multi-level stroke education on treatment and prognosis of acute ischemic stroke
Xiaoman Zhang1, Yinfang Liu1, Xinhui Cao1
1Department of Neurology, The First People's Hospital of Zhengzhou, Zhengzhou, Henan 450004, P.R. China.
Insights
Multi-level stroke education significantly improved patient awareness and timely treatment for acute ischemic stroke. This led to shorter door-to-needle times and better patient outcomes, demonstrating the value of community-wide education.
Area of Science:
- Neurology
- Public Health
- Medical Education
Background:
- Acute ischemic stroke requires prompt medical attention for optimal treatment and prognosis.
- Public awareness and understanding of stroke symptoms and the importance of rapid hospital arrival are crucial for effective intervention.
- Systematic, multi-level education can potentially enhance community and medical staff preparedness for stroke events.
Purpose of the Study:
- To evaluate the impact of a one-year multi-level stroke education program on patient awareness and treatment metrics for acute ischemic stroke.
- To compare outcomes between a population exposed to the education program and a control group.
Main Methods:
- An observational study involving 519 acute ischemic stroke patients admitted to The First People's Hospital of Zhengzhou.
- An experimental group (272 patients) from Guancheng district received multi-level stroke education; a control group (247 patients) did not.
- Data collected included stroke awareness, time from onset to hospital, use of emergency medical services (EMS), adherence to the 4.5-hour treatment window, intravenous thrombolysis rates, door-to-needle time (DNT), modified Rankin Scale (MRS) scores, and hemorrhagic transformation cases.
Main Results:
- The experimental group showed significantly higher awareness of key stroke symptoms like limb weakness, speech difficulty, and facial paralysis compared to the control group (P<0.05).
- Patients in the education group had a shorter time from onset to hospital (14.82±17.67 vs. 25.92±25.23), higher EMS utilization (36.02% vs. 16.19%), and more patients arriving within 4.5 hours (67 vs. 32).
- The experimental group had a higher number of intravenous thrombolysis cases (55 vs. 17) and a significantly shorter DNT (42.43±17.30 vs. 63.35±26.53), with fewer hemorrhagic transformation cases (11 vs. 21) and better MRS scores (P<0.05).
Conclusions:
- Multi-level stroke education effectively improves public and medical staff awareness of stroke symptoms and the critical 4.5-hour treatment window.
- The education program led to increased use of emergency medical services and faster hospital arrival, facilitating timely interventions like intravenous thrombolysis.
- This educational approach shows potential for improving acute ischemic stroke prognosis by reducing DNT and hemorrhagic transformation, without negatively impacting mortality.
Abstract:
This observational study aimed at the significance of multi-level education in the treatment and prognosis of acute ischemic stroke. Multi-level stroke education was carried out among residents and medical staff for one year in Guancheng district. After 1 year, 519 patients with acute ischemic stroke admitted to The First People's Hospital of Zhengzhou were invited to the study, 272 patients from the Guancheng district were divided into the experimental group, and 247 patients who were not from the Guancheng district but in the neighborhood of The First People's Hospital of Zhengzhou were divided into the control group. Statistical methods were applied to analyze the degree of awareness of stroke, the time from onset to hospital, the route to hospital, the number of patients coming to the hospital within 4.5 h, the number of intravenous thrombolysis, door-to-needle time (DNT), modified Rankin scale (MRS) score, and the number of hemorrhagic transformation cases. After one year of multi-level systematic stroke education, there were significant differences in stroke awareness between the experimental group and the control group in terms of limb weakness (87.87 vs. 62.75%), speech inarticulation (78.3 vs. 55.06%), facial paralysis (69.12 vs. 38.06%), limb numbness (57.35 vs. 29.15%), consciousness disorder (62.50 vs. 42.11%), walking instability with severe dizziness (39.97 vs. 15.79%) (P<0.05). There was no statistical significant difference in unclear vision or blind eyes or severe headache (P>0.05). There were statistical differences between the two groups in the time from the onset to the hospital (14.82±17.67 vs. 25.92±25.23), emergency medical services (EMS) (36.02 vs. 16.19%), number of patients coming to the hospital within 4.5 h (67 vs. 32), venous thrombolysis cases (55 vs. 17), DNT time (42.43±17.30 vs. 63.35±26.53), hemorrhagic transformation cases (11 vs. 21), and MRS score grade ≥2 (230 vs. 169) (P<0.05). Multi-level education can effectively improve the patient's awareness of stroke, encourage more patients to use EMS system to the hospital. More patients were aware that they should reach the hospital within 4.5 h. It helps shorten DNT time and give more patients the opportunity to receive intravenous thrombolysis or intravascular thrombectomy, which may improve the prognosis and reduce hemorrhagic transformation without reducing mortality.
